CIOs Bringing Hands-Free Technology to Hospitals

As more states pass laws regarding cell phone use in cars, the carriers have responded by offering voice-activated features. But driving isn't the only activity that requires hands-free usage.

The operations that surgeons perform demand similar functionality. That’s why CIO’s at hospitals around the U.S. are beginning to introduce voice-recognition technology.

“We were looking specifically to interact with our data base for information we needed during the procedure,” said Jeffrey White, head of research and information systems for Miami Children's Hospital's Cardiovascular Surgery department. “In the operating room, you need to be able to access information and record information, and to do it hands-free.”

But the operating room isn’t the only beneficiary. For Gottlieb Memorial Hospital in Melrose Park, Ill., the problem centered upon locating and communicating with staff. This traditionally meant paging people via ceiling-mounted speakers, and then waiting for a call back—a noisy, slow and inefficient way to conduct business.

“We wanted all caregivers, especially nurses, to be able to get a hold of each other quickly and efficiently,” said Mitty Adler, Gottlieb's CIO. “We tried cell phones and pagers, but weren't happy with either one.”

Like White, Adler implemented voice recognition technology. After a buggy start a few years back, speech applications are emerging in enterprise applications.

Silicon Surgery

As operating rooms go high-tech, there is an increasing array of equipment and monitors that surgeons and their support crews need to operate. London-based medical device manufacturer Smith & Nephew, plc. have a created a platform for OR equipment called the digital operating room, which provides a common interface for all the equipment in the O.R.

It enables a doctor to control the heating and air conditioning, move the operating table up or down, change the lighting, and operate any of the medical devices such as pulse monitors, shavers and camera systems.

“It is written on an open architecture,” said Sal Chiovari, vice president for Digital Operating Room. “If a vendor comes out with a product that can be controlled, we can write some code for it.”

Last year, Smith & Nephew introduced a voice interface called CONDOR. With it, the surgeon wears a microphone and activates the system by saying “Condor On.” At that point, a screen displays the devices that are available to control.

The doctor says the name of the device he wants to control and a menu of commands appears. He then verbally selects the desired action from this menu. By limiting the number of commands and displaying these options on a screen, doctors don't need to memorize the available commands.

“It has the capability of doing full language recognition, but we narrow it down to specific medical terms the surgeon will be using,” said Chiovari. “In surgery, you don't want random conversation to start driving any of the equipment, so we made a focused group of commands that were very much isolated to the equipment and the equipment functions.”

Voice control is an optional interface that complements, rather than replaces, touch screens. The operating room staff has the option of using either or both methods.

In addition to controlling the OR equipment, there is also a need to manage the flow of information into and out of the operating room. This has been the focus of Jeffrey White and Redmond Burke's efforts at Miami Children's Hospital The hospital uses a clinical information system, iRounds, from Teges Corporation of Coral Gables Software. White and Burke, chief of cardiovascular surgery, worked with Teges and IBM to create a voice interface for the database.

The operating room has four speakers in the ceiling for the computer's use, and a microphone for surgeon to communicate. White and IBM experimented with different microphones and adjusted the voice application to filter out common noises such as pumps and equipment beeps to prevent interference.

At the start of operation, the doctor directs the computer to read vital data from the clinical database such as the patient's name, diagnosis and the procedure to be performed. This ensures everyone in the room is on the same page before the start of surgery.

Once the surgeon says the word “incision,” the computer times the operation and notifies personnel when they need to perform such actions as giving the patient his next dose of anesthetic. This allows them to concentrate on the patient, rather than watching the clock, and reduces the likelihood of error.

The doctor can also record data into the patient's file during the operation. For example, he can direct the camera to take a picture and record a description rather than having to remember later the specifics of the photo.

“Pictures used to be stored without data because I couldn't enter it while operating,” said Dr. Burke. “Voice opens up an entirely new source of data occurring at the point of care when it is freshest and most accurate.”

Paging Dr. Digital

Adler of Gottlieb Memorial tried using pagers and cell phones to keep in touch with the staff, but found this unsatisfactory. Instead, the hospital now uses wireless communication badges from Vocera Communications.

These two-ounce badges can be worn on a lanyard around the neck or clipped to clothing. The badges access the hospital's 802.11b wireless LAN to connect to the Vocera Server. The server sends messages to another badge over the WLAN, or links to the hospital's PBX to connect to phone lines. The hospital has 320 of the badges, shared by the 800 staff on three shifts.

The badges have a built-in microphone and speaker, and the server uses voice recognition software to interact with the wearer. The user can access another person by name, nickname, external phone number, internal phone extension, job title or other description such as “the nurse covering Room 48B.”

Since the user's location can also be tracked, someone can give a command like “connect me to the nearest security guard.” For privacy, users have the option of plugging a headset into the badge, but in most cases the users will go to a private area or transfer the call to a land line before discussing patient information.

“One of our biggest concerns is with HIPAA (Health Insurance Portability and Accountability Act),” Adler explained. “We did a lot of training on not having conversations about sensitive patient information, and we don't take physician conversations in the patent rooms.”

However, there are some advantages to having the patients hear conversations. For example, when the patient speaks Spanish, an interpreter can be reached through the badge and the conversation conducted immediately without an interpreter having to come to the patient's room.

There are trade-offs, though. The badges have an LCD screen on the back for text messages and email, but that screen is too small to use with the telemonitoring system nurses use to see results from a patient's heart monitor.

Thus certain nurses carry a separate device for that purpose.

Adler said that Vocera is looking at a larger form factor that could also be used for telemonitoring. But she isn't sure if the hospital will change to the larger devices.

“I don't know if we want to go to a dual use for these devices,” she said. “Right now the weight is perfect and the way in which you use it is so easy.”